Comprehensive and integrated action must to control heart disease

World Heart Day is on 29th September
Cardiovascular diseases (CVDs) are the world's largest killers, claiming 17.3 million (1 crore 73 lakhs) lives a year. Risk factors for heart disease and stroke include raised blood pressure, cholesterol and glucose levels, smoking, inadequate intake of fruit and vegetables, overweight, obesity and physical inactivity. Heart disease and stroke can be prevented through healthy diet, regular physical activity and avoiding tobacco smoke. Individuals can reduce their risk of CVDs by engaging in regular physical activity, avoiding tobacco use and second-hand tobacco smoke, choosing a diet rich in fruit and vegetables and avoiding foods that are high in fat, sugar and salt, and maintaining a healthy body weight.

Despite efforts to reduce incidence of heart disease and stroke in Uttar Pradesh (UP) state of India, the rates are on an alarming rise. "The number of angioplasty procedures and pacemaker implantations has increased by almost 30 per cent over the last year" said Dr Rishi Sethi, Associate Professor, Lari Heart Centre, Department of Cardiology, King George's Medical University (KGMU). Dr Sethi was one of the key organizers of the 3rd Mid-Term Intervention Cardiology Meeting of the UP Chapter of the Cardiological Society of India (CSI).

Dr Rishi Sethi said that "over 4500 lifesaving angioplasty procedures and almost 2000 lifesaving pacemaker implantations have been performed in 2011-2012 in the state of UP. The number of these procedures has increased by almost 30% over the last year." The maximum number of procedures in the state is performed by doctors from Sanjay Gandhi Post-Graduate Institute of Medical Sciences (SGPGIMS) and KGMU (Lari Heart Centre), Lucknow.

Noted senior cardiologist, Professor Huay Cheem Tan, who is the Director, National University Heart Center, Singapore, delivered the keynote guest lecture at this meet. 

There is a lot governments can do to nip CVD rates without delay. Comprehensive and integrated action is the means to prevent and control CVDs, said Dr Sethi.

Comprehensive action requires combining approaches that seek to reduce the risks throughout the entire population with strategies that target individuals at high risk or with established disease. Examples of population-wide interventions that can be implemented to reduce CVDs include: comprehensive tobacco control policies, taxation and regulation to reduce the intake of foods that are high in fat, sugar and salt, building walking and cycle ways to increase physical activity, providing healthy school meals to children, among others. There were some initial steps taken to replace 'junk food' from school canteens with healthy alternatives but this hasn't gone too far in terms of implementation in UP state.

Integrated approaches focus on the main common risk factors for a range of chronic diseases such as CVD, diabetes and cancer: unhealthy diet, physically inactivity and tobacco use.

With relation to tobacco control, India luckily has a very comprehensive law (Cigarette and Other Tobacco Products Act, 2003) in place and has also ratified the WHO Framework Convention on Tobacco Control (WHO FCTC). Still tobacco control law is poorly enforced in the country with marginal success. There is no excuse for governments to ensure existing public health policies are strictly enforced and health gains maximised in the society at large.

Ironically it is the government of UP state that is delaying banning of chewing tobacco (Gutkha) in the state, despite number of lifesaving heart disease procedures has gone up by 30 per cent over the last year. According to the Food Safety Standards Act 2006 (FSSA), no food product can contain tobacco or nicotine. Gutkha, chewing tobacco form, is classified as a mouth freshener and Supreme Court of India had stated clearly in 2011 that Gutkha should be considered a food item. So it cannot contain tobacco or nicotine as per FSSA Act. More than a dozen states have banned Gutkha in India already, and fingers are crossed whether UP government will pay heed or not?

Bobby Ramakant - CNS

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